JACK MICHAEL COSTA


Address: 3650 Joseph Siewick Dr, Suite 202, Fairfax, VA 22033-1710
Phone: 7033912516

JACK MICHAEL COSTA (NPI# 1144393935) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1144393935
Entity Type Individual
Full Name JACK MICHAEL COSTA
Credential M.D.
Practice Address 3650 Joseph Siewick Dr
Suite 202
Fairfax
VA 22033-1710
Mailing Address 3650 Joseph Siewick Drive
Suite 202
Fairfax
VA 22033
Practice Telephone 7033912516
Practice Fax Number 7034768244
Mailing Telephone 7033912516
Mailing Fax Number 7034768244
Enumeration Date 2006-11-17
Last Update Date 2010-12-30
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207N00000X Dermatology 0101028288 VA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
VA ANTHEM 003539 01
VA BLUE CROSS BLUE SHIELD 9320 01

Office Location

Street Address 3650 JOSEPH SIEWICK DR
SUITE 202
City FAIRFAX
State VA
Zip Code 22033-1710

Providers in the same location

NPI Name Taxonomy Address Enumeration
1871596692 Noemi S. Dosova Pediatrics 3650 Joseph Siewick Dr, Ste 101, Fairfax, VA 22033-1700 2005-05-24
1215546395 Ryan Lawson Nurse Practitioner 3650 Joseph Siewick Dr, Fairfax, VA 22033-1710 2020-07-24
1043842503 Shereen A Robinson Nurse Practitioner 3650 Joseph Siewick Dr, Fairfax, VA 22033-1710 2020-02-12
1700373982 Brenda D Carpenter Pharmacist 3650 Joseph Siewick Dr, Fairfax, VA 22033-1710 2018-04-13
1487194262 Molly Boyer Broache Nurse Practitioner 3650 Joseph Siewick Dr, Suite 203, Fairfax, VA 22033-1710 2017-02-28
1649714155 About Care Gyn Associates, Pllc Clinic/Center 3650 Joseph Siewick Dr, Suite 309, Fairfax, VA 22033-1710 2016-12-19
1407209307 Tara Lynne Kiser Nurse Practitioner 3650 Joseph Siewick Dr, 400, Fairfax, VA 22033-1710 2016-07-15
1003266552 Thuy Phuong Thi Vo Family Medicine 3650 Joseph Siewick Dr, 400, Fairfax, VA 22033-1710 2016-06-15
1760897342 Melissa Suzanne Rogina Advanced Practice Midwife 3650 Joseph Siewick Dr, Suite 203, Fairfax, VA 22033 2014-06-23
1104230929 Clare Gosek Family Medicine 3650 Joseph Siewick Dr, Suite 400, Fairfax, VA 22033-1710 2014-06-19
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1366074320 Han S Yoo Pharmacist 12200 West Ox Road, Fairfax, VA 22033 2020-02-07
1386137271 Ammar Orthodontics Pllc Dentist 11702 Fiar Oaks Mall, Upper Floor, Fairfax, VA 22033 2018-06-14
1013360940 Kellyn Patricia Dodd Nurse Practitioner 3903 Fair Ridge Dr Ste 209, Fairfax, VA 22033 2016-07-15
1659721363 John Du Od PC Optometrist 12618 Victoria Station Ct, Fairfax, VA 22033 2016-06-14
1568861904 Virginia Cvs Pharmacy LLC Durable Medical Equipment & Medical Supplies 12734 Shoppes Lane, Fairfax, VA 22033 2014-08-21
1649696295 Patrisha Lultschik Nurse Practitioner 12375 Lee Jackson Memorial Hwy, Fairfax, VA 22033 2014-03-06
1912321910 Alyson Huber Nurse Anesthetist, Certified Registered 3600 Joseph Siewick Dr., Fairfax, VA 22033 2014-02-11
1578999314 Aiatulah Surmaty Optometrist 11801 Lee Jackson Memorial Hwy, Fairfax, VA 22033 2013-09-25
1356780928 Ayatallah M. Khafagy Obstetrics & Gynecology 3650 Joseph Siewick Dr Suite 203, Fairfax, VA 22033 2013-06-17
1760726665 Michelle Elise Schwartz Speech-Language Pathologist 3507 Curtice Farm Dr, Fairfax, VA 22033 2012-11-15
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Taxonomy Information

Taxonomy Code 207N00000X
Grouping Allopathic & Osteopathic Physicians
Classification Dermatology

Taxonomy Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1174901953 Amanda Unalivia Dermatology 3700 Joseph Siewick Dr Ste 302, Fairfax, VA 22033-1739 2015-05-12
1134516271 Kathleen Ellison Dermatology 8316 Arlington Blvd Ste 400, Fairfax, VA 22031-5216 2015-04-15
1508276619 Charles Martin Aaronson Dermatology 3606 Lido Pl., Fairfax, VA 22031 2014-04-29
1740359017 Moses K Albert Dermatology 3025 Hamaker Ct Ste 300, Fairfax, VA 22031-2237 2006-11-08
1205212933 Dermatology of Virginia Dermatology 3930 Pender Dr, Suite 210, Fairfax, VA 22030-0985 2015-08-04
1861890303 Integrated Dermatology of Fairfax, LLC Dermatology 10721 Main St Ste 200, Fairfax, VA 22030-6913 2014-12-16
1497173512 Michele Zerah Magnino Dermatology 3025 Hamaker Ct Ste 300, Fairfax, VA 22031-2237 2014-04-05
1457796641 Renascance Dermatology PC Dermatology 3620 Joseph Siewick Dr, Suite 303, Fairfax, VA 22033-1756 2013-05-01
1093158461 Monica Nabil Saleh Valentin Dermatology 11351 Random Hills Rd, Fairfax, VA 22030 2013-04-16
1245404276 Carol L Piatt, Md, PC Dermatology 8301 Arlington Blvd, Suite 501, Fairfax, VA 22031-2902 2008-04-22
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Competitor

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City FAIRFAX
Zip Code 22033

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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